HomeMy WebLinkAbout2023 Sign off Transmittal - Finish Basement °i..:Ya . TOWN OF YARMOUTH
i :., '`' HEALTH DEPARTMENT
�'r';"`' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: s J o k,r, /- A-(( C, .r.t..j
Proposed Improvement: •Pt,a is k I /Ise- .-vJ r 1(e tRtj -k. 3- S.7-aco?V- A(ZI 9 .
Applicant: Li Sty,L{�rq _ Tel. No.: ?ref-- 7/
Address: ID �� 7(-t-ct 5 .b��/A)/ S k A4- 0 z4 .00 Date Filed:
**If you would like e-mail notification of sign off please provide e-mail address: St7W4 p Ut tsttm /A.M(( _ co . _
Owner Name: CIAALicei AiL4.447,1
Owner Address: g a 4* i0,4) Owner Tel. No.: 7 8 l - 2-tt t & t.)
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
RECEIVED (1.) Site Plan showing existing buildings, water line location,
MAY 15 2023 and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (all existing and proposed)—
Note:Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title S application signed by licensed installer
with fee.
REVIEWED BY: c ..x;, \7
DATE: g- l 5 -r„2 '
PLEASE NOTE
COMMENTS/CONDITIONS:
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